CHAPTER 4: RESULTS
4.3 Study findings
4.3.3 Stigma and Discrimination
facilities but there is still a need to train them further so that they comply with all the required ethical procedures such as keeping the clients’ status a secret.
“Being a counselor is not an easy job. Again, you cannot be a counselor unless you receive a required training. A trained counselor is able to identify cases that are not easy to spot such as patients that are not adhering to the medication. I think that all our counselors should receive proper training in psychology and other related courses.
Sending our counselors to universities or technikons would be very helpful in this field and to many people that need counseling”(Counselor #1).
There is also a need for counselors to be trained on psychological issues. According to the respondents, this would help many patients and would improve the number of people utilizing the services.
From the interviews it would seem that the heath sector is not training health care providers on the management of HIV and AIDS. There is a lack of knowledge about caring for HIV and AIDS patients among the health care providers. Some of them never attended training on the management of AIDS patients and they have a problem caring for these patients. There was confidence among those who attended training on how to manage HIV patients as compared to those who had not attended training. Shortage of staff in the health facilities was identified as a major reason that some member of staff did not attend training. Training of counselors at a higher level was also mentioned as a necessity. There is a need to train lay counselor at a university level and strengthen their capacity in terms of service delivery.
understanding of HIV and AIDS, stigma and discrimination are still challenges that obstruct people from knowing their status (Parker, Aggleton, Attawell, Pulerwitz and Brown, 2000). This results in people not seeking care or advice until it is too late when they are very sick and have full-blown AIDS. Again, a great deal of unnecessary premature deaths occurs because people are afraid of discrimination and stigmatization.
The problem of stigma and discrimination is not only at the community level but also at the health facility level even among other health care providers. The results from most of the participants indicated that HIV and AIDS is still highly stigmatized. The health care providers mentioned that they are scared to undergo the HIV test because they fear that they might be stigmatized if their results are positive.
“I will not test for HIV; I am doing fine without knowing my status. I would rather not know whether I am HIV positive or negative. I do not think I can ever bear being discriminated here at work and at the village where I live. I know that once people know about my status here, the information will soon leak to the community I am serving. I have seen people being refused services at community level such as not being allowed to participate in some of the activities in the community. Children are being called names because their parents are either HIV positive, ill with AIDS related diseases or died of AIDS. I do not want my children to go through all that because of my HIV status”(Nurse Assistant # 2).
“We are trying our best to counsel people to deal with the fact that they have HIV however, many people do not understand what they are being told by the health care providers because they fear that they will be stigmatized in their families and villages.
They do not understand that they can take HIV as any other condition that one can be in.
The only thing they think about is to be called names and be secluded from some of the important functions and activities in the families and communities. We also need counseling because we have the same fear as the rest of the population that people will look down upon us and start to call us names. What is worse is that people are looking up to us to save their lives as care providers and if we get sick from this disease we fear that
people will lose hope and never trust health care providers. They will even think that, the health care providers that are HIV positive will infect them” (Registered nurse # 4).
It seems that the fear of stigma and discrimination are the main factors preventing men and women from coming forward to test for HIV. They are scared of being told that they are infected. The fear mainly emanates from stigma and discrimination surrounding HIV and AIDS. The health care providers are also scared that their positive results would affect their children as well. They indicated that they had observed that some HIV infected individuals are denied some of the services in their communities.
The association of HIV and AIDS with promiscuity is still prevalent and health care providers are not the exception in this regard. Most people are scared that if they turn out to be HIV positive, they would be seen as having behaved badly. There is still stigma and secrecy surrounding this disease. It is clear that some the health care providers would not just take HIV test unless they became ill and are requested to undergo a blood test. They mentioned that people talk behind their backs if they suspect that one has some symptoms such as coughing for a longer period or having lost weight.
“You will be surprised that we as health care providers do such things as gossiping about each other. If one of our colleagues shows some HIV related symptoms such as weight loss, or being suspected to have TB other colleagues start talking behind his or her back. As a person, you realize that even if I have had HIV I would not disclose my status in this place. This is not the right place for me to talk about something like that.
You can imagine that I am talking about the health facility and the health care professionals” (Counselor # 1).
Health care providers do not trust each other in terms of disclosing their HIV status at their workplace. There is lack of privacy among them. They indicated that there is gossip about other members of staff that are suspected of being HIV positive.
“I have learned from my colleagues that health care workers cannot just take an HIV test. I think just like our patients, we are afraid of getting positive results. AIDS is scaring us like any other human being. The way it was introduced to everyone when we first heard about it was scary to everyone” (Nursing assistant # 2).
The health care providers indicated that HIV scares everyone regardless of their profession. They themselves are health care professionals and some of them have received training on HIV and AIDS thus, how it is transmitted, preventive methods and management of AIDS patients. Regardless of all these, fear of contagion among the health care providers still exists. There is also fear of being identified as ‘a person who has that disease’.
Apart from the pressure at work, health care providers are living in communities where people with AIDS suffer discrimination. HIV is mostly associated with promiscuous behaviour. Some of the health care providers come from rural areas where knowledge about HIV is still a problem. If people get to know that the health care provider is HIV positive they can discriminate against her. The respondents mentioned that people might even stop seeking health care services from the facility where such an individual is working. The challenging part about being HIV positive in the community as stated by one of the health care providers is that you are not the only one but also your children and the rest of the family will also suffer from discrimination.
“Your children will not play freely with other children because those children would be warned by their families not to mix with them. Sometimes when these childrens’ parents see them playing with yours they call them and tell them not to mix with your children.
This is really hard” (Registered nurse #2).
“People forget that health care providers are human beings. You will find that if a care provider is gay they cannot just come forward to disclose their sexuality. They keep this as a secret because of the stigma surrounding it. If they become HIV positive, they then
keep a much heavier secret because they are afraid of being judged that they have the disease because of their sexuality. They fear suffering double stigma, of being homosexual and also being HIV positive” (Counselor #1).
The health care providers like all people are concerned about their HIV status. They are also scared to undergo the HIV test and they would not want their status to be known by other people even their colleagues particularly if they are HIV positive. HIV and AIDS is incurable and is a fatal disease and it is also associated with promiscuous behaviour.
Therefore, no one wants to be associated with the disease. There is a great deal of stigma attached to the disease and people living with HIV and AIDS often suffer discrimination.
The study also discovered that health care providers would not just come forward and disclose their sexual orientation. They are concerned about the impact of a HIV positive result on their family members.
Generally, there is no trust among health care providers with regard to disclosing their HIV status to colleagues. The issue of stigma and discrimination that is prevailing in many communities is also common in the health sector. This seems to prevent many people from taking the HIV test and knowing their HIV status. The health care providers are scared that if they test for HIV and come out positive, they will not get the necessary support from their colleagues instead they will become the subject of gossip.